The Chronicle of Healthcare Marketing - November 2015

Inside: Canadian Healthcare Marketing Hall of Fame Commemorative Booklet

OUR ANNUAL REPORT ON MARKETING: Charting the modern evolution of the agency/client relationship • 4 OTSUKA CANADA: GM Allison Rosenthal explains the science behind corporate culture • 5 MY TURN: Local governments contributing to Canada’s $500 million drug problem • 14

$7.95 • November 30, 2015 • Covering Canadian and Global Pharmaceutical Economics • www.pharmacongress.info

Biosimilars market a little murky SEBs

Publications Mail Agreement No. 40016917

n Not considered generics by Health Canada, since it is virtually impossible to make identical product

T

By Ian J.S. Moore

HEALTHCARE MARKETING

HERE IS SOME CONFUSION AROUND

Girls just want to have fun

Pop stylist Cyndi Lauper is heading up an awareness campaign for the National Psoriasis Foundation to highlight the physical, emotional and social challenges of living with the disease. With sponsor Novartis, Lauper aims to inspire people with psoriasis by describing her own experiences. “[Psoriasis] made me want to hide, but being in the public eye I knew I couldn’t stay inside,” she says. (PR NewsFoto/National Psoriasis Foundation)

Pharma industry growth pegged at about 5 per cent annually through 2019 The business of pharma

© MMXV, All rights reserved. Chronicle I/R Ltd.

of THE CHRONICLE OF

n Top 15 brands growing, but none has a market share that escapes single digits

C

By Ian J.S. Moore,

for THE CHRONICLE OF HEALTHCARE MARKETING

ANADIAN PHARMAS’ TOTAL MARKET

purchases will grow to $29.6-billion in the five years between 2015 and 2019—an increase of $5.1-billion— according to forecasts delivered by IMS Brogan prexy Michael Brogan during his annual PharmaFocus 2019 presentation in Toronto.

The recorded annual percentage growth is expected to be between 4.9 per cent and 5.3 per cent during this period, he said.

Using actual market prices in its forecasts, the company says brand products will lead the way, growing to $23.86 billion in 2019 from $19.23-billion in purchases this year, an impressive gain of $4.63-billion (all figures are in Canadian dollars).

Sales of generics will also increase during this period, but by a less impressive

$520 million to $5.81-billion.

Brogan said pharmas’ market growth projections are optimistic, as the company’s figures and charts showed the industry is emerging from the gloomy, recessive market growth situations it experienced in recent years.

“We expect to remain out of [recessive growth] for the foreseeable future.” he said.

Brogan A growth in the sales of Hepatitis C medications, the pan-Canadian Pharmaceutical Alliance, and considerations by both private payers and the federal government of joining the pCPA can be counted among the drivers in this growth forecast.

Also taken into consideration is the expected sales growth in subsequent entry biologics (SEBs) and inhaler products.

The list of top 15 brands last year presented a mixed bag of sales and growth increases. While Lucentis, Cymbalta, Humira, Remicade and Coversyl were leaders with double-digit percentage market growths, their market shares were all lower, single-digit numbers.

REMICADE IN LEAD

At 3.4 per cent, Remicade claimed the leadership title in purchase volume by brands last year; none of the other top market growth leaders reached more than the 2.2 per cent recorded by Humira.

The “wild card” in 2015, according to Brogan, will be the sales totals achieved in

Turn to Canadian Pharma page 8à

the manufacturing and marketing regs governing biologic biosimilars and subsequent entry biologics, if questions from the floor are any indication.

During a presentation at the PharmaFocus 2018 meeting in Montreal, Anne Tomalin, president of Therapeutic Products Inc., a boutique firm in Hamilton that deals with Canadian regulatory affairs, clarified some issues and misconceptions.

A biologic, she explained, is a medicine made from living organisms or cells through a complex manufacturing procedure, and the smallest change in this procedure can affect the final product and its effect in the human body.

A biosimilar is a copy of a biologic that is similar, but not identical to, an original medicine.

BIOSIMILARS NOT IDENTICAL

“Think about a generic small molecule,” she said. “A generic small molecule is the identical amount of the identical ingredient in a similar dosage form for the same indication [and] taken by the same route of administration.

“It’s much, much more difficult when you get to a biologic. You really can’t tell that they’re identical anymore.”

Health Canada’s defines these products as Subsequent Entry Biologics (SEB), but in Europe and other countries they are generally known as biosimilars.

“A subsequent entry biologic [in Canada],” Tomalin said, “is a biologic drug that enters the market subsequent to a version previously authorized in Canada and with demonstrated similar-

Turn to Biosimilars page 10à

TOP TEN SIMPLE INVENTIONS THAT DIDN’T CHANGE THE WORLD. CRANIAL GREETING CARD BOOB TUBE

Patented 2000. Now you can look like a cartoon character with your own head-hovering thought balloon!

Patented 1992. This foul weather suit is designed to protect you while allowing a clear view for your fellow spectators.

BUNNY SYRINGE

th

Patented 1967. The Bunny Syringe was invented to ease the inevitable for the kid and the doctor.

Y P P 40 A H

DIMPLE DRILL GERBIL SHIRT

Patented 1896. To produce the dimple, simply press the Dimple Drill’s tip on the desired area and turn the knob.

Patented 1999. Tired of leaving your small pets at home? The Gerbil Shirt wraps your torso in plastic gerbil passageways.

LEAF CHAPS Patented 2003. With the ingenious Leaf Chaps, you can shuffle your way to a clean yard as the webbing gathers leaves into a pile.

INSECT BALLS Patented 1990. Spray a ball with insect attractant, and you now have a herd of gnats hovering less annoyingly above your head.

TOILET SNORKEL Patented 1982. Avoid smoke inhalation in a fire by snaking a snorkel through your toilet, so you can breathe (albeit sewer air).

STUD SPECTACLES Patented 2003. A new way to hang eye glasses on your face, by using body piercing studs!

BOAT BALL Patented 1973. Unlike your everyday boat that drags through the water, this giant motorized ball fl oats over the surface.

Strategy • Creative • Rep Tactics • CME • Patient Adherence Programs • DTC • James Cran 416 926 2126 or 514 989 3157 • www.antibodycommunications.com

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Healthcare, Inc.

The Chronicle of Healthcare Marketing

NOCs of Note: November 2015

Significant TTP approvals of Rxs for human use

Cholinesterase inhibitor 10-02 Rivastigmine hydrogen tartrate (Exelon, Novartis Pharma). Comments: Changes to the drug substance manufacturing process, and addition of drug substance manufacturing site; 1.5 MG/CAP, 3 MG/CAP, 4.5 MG/CAP, 6 MG/CAP, oral

Angiotensin II receptor antagonist/neprilysin inhibitor 10-02 Valsartan/sacubitril (Entresto, Novartis Pharma). Comments: valsartan 25.7 MG/TAB/sacubitril 24.3 MG/TAB; valsartan 51.4 MG/TAB/sacubitril 48.6 MG/TAB; valsartan 102.8 MG/TAB/sacubitril 97.2 MG/TAB, oral Beta lactase inhibitor 09-30 Tazobactam sodium/ceftolozane sulfate (Zerbaxa, Merck Canada Inc.) Comments: tazobactam sodium 0.5 G/VIAL/ceftolozane sulfate 1 G/VIAL, lyophilized powder for solution

Tumour inhibitor 09-28 Bevacizumab (Avastin, Hoffmann La Roche Limited) Comments: New indication: Turn to NOCs page 12à

November 30, 2015 · 3

Txs, formed by the Ontario Institute for Cancer ZALICUS PHARMACEUTICALS, the Up Here Research and the University Health Network, Vancouver-based developer of pain What’s happening in drug marketing two provincially-funded entities. Janssen will Rxs, was acquired recently by TARO offer Cdn$450 million in milestone payments, PHARMACEUTICALS. Taro is the US and gets global commercialization rights to blood Ca Rxs. The comsubsidiary of SUN PHARMACEUTICALS of Mumbai, the leading pany will also pay up to Cdn$441 million to enGene of Montreal, Indian drugmaker. Zalicus, once known as Neuromed, has been which is developing a Tx for inflammatory bowel disease. Janssen owned by Epuris Biopharmaceuticals of Boston since last year. maintains other JLABS facilities in California, Massachusetts and (Epuris is the Canadian product name of Cipher Pharmaceuticals’ Texas. formulation of isotretinoin, which, to further add to confusion, is distributed in the USA by Sun Pharma’s Ranbaxy division.) Zalicus is SANOFI-AVENTIS Canada, after consultation with Health Canada, is working on pain management candidate Z944. The company sold for recalling epinephrine pre-filled auto-injectors (Allerject) over concerns $7.6 million, half in cash. about dosing levels. Units are also being recalled in the USA, where the product is branded Auvi-Q. Patients have been asked to exchange On average, fewer Canadians have drug coverage than residents of all Allerject (DIN02382059 and DIN02382067) at their pharmacies. other developed economies, excluding the USA and Poland. Canada also has the dubious honour of spending the fourth most per capita for Rxs among 29 industrialized nations, exceeded only by the USA, Japan and Greece. Those finding come from a biennial report recently issued by the Organization for Economic Co-operation and Development, titled “Health at a Glance.” The OECD reports governments typically pay for 36 per cent of drug costs in Canada, while individuals pay 34 per cent, and private insurers cove 30 per cent.

Health Canada okayed MonaLisa Touch, a laser procedure for Tx of genitourinary symptoms of menopause, marketed by CYNOSURE. According to the company, the device was designed and produced by the Italian company, and delivers fractional CO2 laser energy to the vaginal wall tissue. Cynosure says symptoms include pain, dysuria and dyspareunia, and affect half of all postmenopausal women. The stateside FDA cleared the device last year.

JANSSEN BIOTECH, the JOHNSON & JOHNSON unit, penned two R&D deals in advance of its new downtown Toronto incubator lab complex scheduled to open next year. The facility, called JLABS @ Toronto, is a collaboration of Janssen, the University of Toronto, and the Ontario government’s MaRS research initiative. The company entered a pact with Novera Therapeutics, a startup noodling out Ca

Professional Pearls

Big Data: It is hard to make good decisions without good information, but gathering information takes time and money. Industry veterans speaking at the National Pharmaceutical Congress were asked to share their thoughts on the knowledge essential to pharma decision-makers in coming months.

Big data analytics or an open mind? 4 key points

Mark McElwain, formerly senior vice president of client services, kbs+ Toronto There have been massive estimates about the potential value of ‘big data’ to the pharma industry, but we have to ask who will be using this data; who will be making the decisions?

‘Essential knowledge’ may be better understood at the skills and background of the people making executive decisions, rather than masses of data about consumers. What skills will be needed by the decision-makers in the next 10 years as the pharmaceutical market changes?

With the industry changing in a myriad of ways—changing regulations, expansion of foreign and developing markets, increasingly empowered patients, and increasing payer pressure—a broad range of skill sets will be needed, from bench scientists to IP lawyers and business graduates, as well as database analysts to manage the ‘big data.’

Executive decision-makers need to have the knowledge to understand and work with the reports they receive from their data analysts, and know how to ask for effective and informative refinement of that data.

What’s driving the interest in big data? 4 key points

Michael Tremblay, president of Astellas Pharma Canada Inc. Payers talk about tracking treatment outcomes, but are not really acting on it. It is in the interest of pharma to collect their own data on patient outcomes in order to show value.

Provincial health agencies do not seem to be certain which data they want from pharma companies, so it is an asset to be able to have as broad and deep a data set as possible in order to respond to new requirements in a timely manner.

Real-world data will be crucial in the future: That’s knowing the outcomes real patients achieve with products, not just clinical trial data.

In the US, integrated care organizations encompassing pharmacists, front-line care providers, and insurers are emerging and collecting longitudinal patient data. Co-operation with groups like these can aid in decision-making which ultimately helps our patients.

4 · November 30, 2015

Special Report

The Chronicle of Healthcare Marketing

As pharma consolidates workforces, agencies scramble to

pick up the slack

evolving agency-client relationship The

Image courtesy Petr Kratochvil

ACCORDING TO THE DICTIONARY definition, a partner is “A person who is associated with another or others in the carrying on of a business with shared risks and profits.”

It’s a useful definition to keep in mind these days when talking with execs and managers in the advertising and healthcare communications biz because “partner” is the word used almost exclusively to describe their idea of the ideal agencyclient relationship with pharmaceutical companies.

“We expect to be involved and we expect to be engaged,” says Lisa Barbusci regarding what she considers to be essential to a successful agency-client partnership. Barbusci is managing director of the Canadian office of the CDM Group in Montreal. ”We have a lot of clients who use us for our strategic involvement and the strategic considerations we provide,” she continues, “but that can only happen to the extent they let us into their business.”

Getting the agency and its employees involved as early as one year pre-launch gives the group a sense of ownership in the project, Barbusci says, adding that not all clients believe it necessary to have their agency involved at such an early stage.

“It’s probably the number one thing that we would request from our clients and maybe one of the things they struggle with a bit the most.”

This SPECIAL REPORT was compiled

by Ian J. S. Moore, a frequent contributor to THE CHRONICLE OF HEALTHCARE MARKETING.

TREND AWAY FROM GLOBAL CREATIVE

Putting the local national finishing touches on a global campaign conceived at the offshore HQ may not be as in vogue as it was a few years ago, she says regarding clients’ expectations of their agencies.

“I don’t know of a lot of clients who are looking for just Cran that anymore. The world of localization of materials isn’t necessarily a way for agencies to make a living anymore.

There’s not a lot of longevity in that, and you’re easily replaceLavenue able if that’s all you’ve become in the market.

Like many other observers, Barbusci notes that recent mergers and acquisitions plus other factors have obliged pharmas to work with fewer sales, marketing and product managers, and are counting on their agencies to do more of the heavy lifting in sales and marketing programs.

“More and more clients are relying on us to be the second or third head at the table. And it’s probably true to say that creativity has taken a back seat to strategy,” she said.

What pharma clients prize most in their agencies is experience in the form of a team, according to Cameron Bradley, vee-pee, client services at Brightworks, Toronto.

“They’re looking for a team that’s

knowledgeable, that understands the industry and the space (pharmas) are competing in—the regulatory environment and the competitive pressures—and certainly understanding ‘the latest and greatest’ in terms of the channels and tactics that are out there in the market place.”

Hara

MARKETING BEING CHALLENGED MORE

Given the market conditions today, Bradley says, clients have placed a greater emphasis and scrutiny on ROI when they sit down to evaluate projects their agenLagace cies propose or execute.

“It’s not so much focusing on agencies, as it is on their internal stakeholders challenging marketing a little more than previously.

Everyone underRoy stands that marketing works, but they want to understand how well it works and which tactics work better and ‘do we really need to spend a million dollars when maybe we only have to spend half a million.“ Some clients, he notes, can be direct and specific in their briefings, describing their expectations of a project’s results.

Others are more general, presenting the

goals as a challenge, and waiting to see and evaluate the agency’s response.

Bradley favours the concept of the agency-client partnership inherent in presenting a project as a challenge, believing clients get more value when they’re not issuing specific directions.

“Show me the goal post,” he says.

“Give me directions on what you’re looking to accomplish, but don’t constrain me saying you’ve got to get down there in four running plays and using only three pass routes.”

In the past 10 or 15 years pharmas and their agencies have lived through a major changeover in the way their companies are regulated and how they conduct their affairs within the healthcare and pharmaceutical industries, according to James Cran, co-founder and main man at Antibody Communications in Toronto.

Successful market launches and continuous market heft, if not dominance, comes only when both agency and client learn the business through a successful partnership, he maintains.

“Basically a ‘successful business’ all comes down to an alliance of agency and client,” Cran said, comparing how projects today are tandem efforts.

And, he says, both pharma and agencies face the same hurdle—operating profitably in a digital age where major changes buffet the business environment more often and more quickly. The opportunity for major sales by any medication manufacturer is limited in 2015 by several factors, in particular reimbursement and payer policies, generic entries and adoption of new therapies by physicians.

“Today, pharmas and their brands

Turn to Report on agencies, page 11à

November 30, 2015 · 5

The Chronicle of Healthcare Marketing

Otsuka Canada and the science of corporate culture Pe o p l e : T h e 5 t h P o f M a r k e t i n g

P

n Establishing and maintaining a positive culture called the foundation of Otsuka’s operations

KOTLER SAID IT WAS Purpose. Ries and Trout famously extolled Positioning. But the best marketers know that the 5th P, People, is the key to success. In the latest of a series profiling exceptional leaders in Canadian healthcare marketing, we spoke with Allison Rosenthal, General Manager at Otsuka Pharmaceutical Canada The notion that human values are at the core of a company’s success is nothing new.

Those values start at the top and should be identified with a clear mandate to reach all levels of an organization.

And while it’s great to have a values statement, how do you make it stick and how do you measure progress as you go along?

Rosenthal told us that while most companies strive to have a positive culture, Otsuka makes it the absolute foundation of the company’s operations.

“Otsuka is from Japan, where it was founded in the 1920s. It is a company founded on a philosophy of specific values, such as encouraging debate, challenging the status quo, and diversity of thought and experience,” Rosenthal explains. These values were at the forefront when the company expanded to Canada in 2010.

HILIP

IMPORTANCE OF CULTURE

Another reason culture is so important to Otsuka Canada is that the company now has 90 employees, most of whom came from “big pharma,” companies with household names, long histories in North America and, of course, their own corporate cultures.

Otsuka considers this diverse group an opportunity to build something rare and create a new and innovative culture of their own. “We visit our culture every day,” Rosenthal says. “Each of us joined this organization for a reason and the values we share inform why we are different and how we are different. You could stop anyone in the hall and ask for our company’s values and that person could list them.”

So, how does Otsuka Canada manage their culture and ensure that it continues to be the lifeblood of the company’s operations? One way is to measure it with the help of an external survey.

That’s where Dr. David Jamieson comes in. He is chief scientist and head of advanced analytics at Environics Research Group. Well known for regularly taking the pulse of Canadian values for more than 40 years, the

company is now helping corporations big and small define, measure and maintain their values and culture.

The company’s entropy scores (distortion between employees’ values and the company’s vision) are extremely low and, while this is great news, they are careful to “keep the magic going” as Rosenthal puts it. “We also publicly thank our people for doing good things, and we make sure the onboarding process includes meeting and getting to

Rosenthal

Using measurement tools such as regular surveys, 360degree assessments for leaders and on-boarding evaluation, companies can begin the important business of changing or bolstering their culture. The process, depending on the size and scope of the organization, can take anywhere from one to three years.

“It takes courage,” says Jamieson, “both to take on the challenge initially, and to consistently pursue the goal of consciously re-making cultures.

Corporate culture starts at the top and leaders require self-understanding to make the process meaningful and permanent.”

Jamieson

know each and every employee, not just those in that person’s department.

“There are no silos here,” she adds.

Also, the company does not hold sales meetings. The meetings

are for everyone, from the person who answers the phone to the top sales person. “I’d rather have us all together here in Montreal than a select few at some exotic locale,” Rosenthal says.

“Everyone rowing with the same stroke,” is how Jamieson puts it. “The culture ripples down to all levels and brings in a new openness and productivity to the organization.”

As well, any outliers are now clearly identified and will eventually make their way out of the mix.

That means efficiency and increased profitability as the company moves forward with a clear vision of what it has chosen its identity and culture to be. Onboarding is easier, as is selecting individuals who fit into the defined culture using the measurement tools developed. Momentum is built, driving the company forward

to where it wants to be.

Rosenthal knows that while they are doing the right things, there is always room for improvement.

“We need to take our great results and grow. We have plans for our management group to work with Dr. Jamieson from Environics and Rob Seguin from The Productive Leadership Institute this fall as part of our efforts to never stop working on improving our culture,” she explains.

And, in the end, people are fulfilled because they are doing meaningful work that is grounded in values instead of grinding gears. That shifts the needle toward happiness.

“It’s like engineering an opportunity for everyone to flourish,” says Jamieson. “And that is good for the company, and its people.”

This is the fifth instalment of THE CHRONICLE OF HEALTHCARE MARKETING’s feature on exceptional leaders in the Canadian pharma industry.

The series was developed by Rob Seguin and Christine Woodley of LMI Canada/The Productive Leadership Institute, in conjuuction with THE CHRONICLE. In this issue, they speak with Otsuka’s Allison Rosenthal.

VALUES MUST BE A GOOD FIT

So, why do it? It’s a lot of slugging, self-analysis and time-consuming measurement. But for Otsuka Canada, it’s just one of many ways the company keeps culture at the forefront. In addition, Rosenthal herself interviews every candidate being considered for hire in order to ensure the person’s values are a good fit.

CeraVe renews partnership with USA Swimming

Valeant’s CeraVe has announced the continuation of its support of the 400,000-member organization USA Swimming. CeraVe is the exclusive skin care sponsor, and the renewal is effective through 2016. “We are very pleased to continue our partnership with USA Swimming,” said Joe Gordon, general manager, consumer health care, at Valeant Pharmaceuticals.

When you’re always bleeding, it’s hard to think of anything else.

For women with uterine fibroids, excessive bleeding is the most common and concerning symptom. It influences the clothes they wear, their social life, even their attendance and performance at work. Let’s make treating the underlying problem a primary goal.

Choose Alvesco® first. Demonstrated effective symptom control with an excellent safety profile.

MAGIC + LOGIC healthwisecrg.com

6 · November 30, 2015

The Chronicle of Healthcare Marketing

Digital devices for fashion, or medical care?

Te c h n o l o g y

n Survey shows one-quarter of US population has purchased a digital health device, but only 2 per cent use them

T

By Ian J.S. Moore, for THE

CHRONICLE OF HEALTHCARE MARKETING

HERE IS NO QUESTION THAT

wearable tech in healthcare has arrived, according to a presentation at a session hosted by the Ontario Pharmaceutical Marketing Association.

Neil Follett, main man at

G IN E E M R O C T H IN S O T T IE 6 1 I C 20

Toronto-based Brightworks and moderator of the OPMA meeting, referred to Forbes blogger Dr. Robert Glatter, who believes that while this is just the start line for the use of technology and innovation in the healthcare field, the general population does remain skittish about the value of wear-

able healthcare devices.

In a recent blog, Glatter reviewed the findings of a PricewaterhouseCoopers’ HRI report which noted that fewer than half the people with wearable devices use them on a daily basis. According to the report almost one-quarter of the US

population has purchased a device but only two per cent use them and 10 per cent of this group had ended up throwing them away.

DOCS OPEN TO E-VISITS

A more recent HRI report said that MDs have a growing acceptance of these devices and are

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open to adopting digital technology into their practices.

“Delivering enabled care is no longer nice to have, it’s fundamental for delivering high quality care,” the report determined.

This survey—Healthcare delivery of the future; how digital technology can bridge the gap of time and distance between clinicians and consumers— relied on the opinions of more than 1,000 industry honchos, doctors, nurse practitioners and physician assistants.

The report noted that digital doctor-patient interactions could be increased. Almost 42 per cent of doctors relied on home test results before writing their scripts, and almost half said evisits could substitute the traditional in-office meeting. Close to the same percentage of patients indicated they would be willing to discuss their case online, Follett reported.

Apps, the report suggested, could also be used to promote self-management of disease.

More than one-quarter (28 per cent) of consumers reported their mobile devices contained an app, and two-thirds of responding MDs agreed they would prescribe the use of an app to help handle and treat a chronic illness.

HRI also recommended that those involved in healthcare use analytics to achieve better outcomes and access more technical data that could help to reduce workforce costs and improve work quality.

Using digital technology in areas where it could replace traditional procedures would also be a good idea.

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“We’re in that shifting out period where wearables is the really new, shining, interesting object,” Follett said of current digital developments, products and retail outlets.

“Do we really need Internetconnected underwear? We’re not sure but someone right now is looking far on to having your underwear connected to your phone and app.”

“We can’t operate without them,” according to Alex Dolan, a co-founder with brother Eric of Neuton, a start up firm manufacturing a new smart watch that surveys and tracks multiple seizures.

“Depending on the particular forecast, we looking at a range of between $6-billion total market cap to $26-billion market cap at a compound annual growth rate of 35 per cent,” he claimed.

Turn to Digital page 8à

November 30, 2015 · 7

The Chronicle of Healthcare Marketing

US FDA continues to regulate pharma Tweets Communication

n Guidance for social media initiatives down south reflects best practices outlined by PAAB in Canada

H

By Emily Innes, of THE CHRONICLE

OF HEALTHCARE MARKETING

OW MUCH INFORMATION

can you fit into 140 characters? That’s the question US pharma companies are trying to answer after new FDA guidance (Answer: that was 140 characters).

In the summer of 2014, the US Food & Drug Administration (FDA) issued a draft guidance that addresses practices surrounding primarily Twitter and Google search engine marketing.

The document, called “Guidance for Industry Internet/Social Media Platforms with Character Space Limitations—Presenting Risk and Benefit Information for Prescription Drugs and Medical Devices,” states that social media with limited character space must include accurate and non-misleading benefit and risk information.

“The guidance, as written, essentially does not allow you to do branded ads with claims, essentially known as DTC or direct-to-consumer marketing because of the restrictions and the way you have to include the indication and the fair balance information,” says Brad Einarsen, director of digital insight of the Toronto-based digital marketing agency Klick Health.

Though this is what the industry had been doing as their best practice, according to Einarsen, this guidance was welcomed because it reassures companies that they were on the right path.

“Basically, we are really happy and excited that the FDA is releasing these guidelines for marketers to help us define where the guard rails are,” says Einarsen.

“We might not always like that the restrictions are put on us, but we respect them and we respect why the FDA does it. It is much better to know where the guardrails are rather than to try and figure it out on your own.”

MORE SOCIAL MEDIA PROJECTS

US companies might be trying to figure out more ways to fit information into 140 characters because they are more comfortable now that guidelines are in place.

“Pharma companies can now look at this guidance and say ‘this essentially enshrines what we were doing and what best practice was. We can be confident and maybe do some of the projects we had on the backburner because we were worried about

regulatory uncertainty,’” he says.

What is acceptable under FDA guidance and what was standard practice are reminder and health-seeking advertisements. These advertisements through social media, according to Einarsen, are useful to demonstrate to physicians and patients that the pharmaceutical company is an expert in the field, which builds trust.

BEST CHANNELS SHARE INFO

“What we see in the industry with the best channels is that you can provide interesting and helpful information for patients on either an unbranded channel or even a branded channel without mentioning claim and you can provide a very valuable service for patients by curating third party materials by talking about the condition and where to find help,” says Einarsen.

Where social media becomes difficult is not the inability to have DTC ads but the regulatory overhead that makes it hard to create conversations and interactions, says Einarsen.

“Consumers on Twitter are not really tolerant of things being slow,” he says. “It is much better for a pharmaceutical company to be very upfront and say ‘we can’t necessarily respond.’”

Einarsen continued, “They can use the channel to get the message out and when someone re-Tweets them or talks about their materials then that can happen and they are not involved in that conversation and that is

OK.” The guidance also focused on Google search engine marketing and Einarsen says the FDA has made this a bit of a complicated affair. Similar to Twitter, the FDA stipulates that pharmaceutical companies must include the benefits and the risks in Google search engine marketing links by using Google’s enhanced site links. Though it “looks like it would really work,” Google cannot guarantee these enhanced site links will appear with every link, creating a Catch-22.

“The problem is that the FDA is not going to accept the excuse that we tried to do what you had in your guidance. That is like telling a police officer that you didn’t see the sign so that

toward Canada because it has been ahead of the curve on social media regulations.

In July 2013, the Pharmaceutical Advertising Advisory Board (PAAB) revised section 6.5 of their code to address pharmaceutical’s social media use. As on other platforms in Canada, DTC advertising is not permitted through social media.

Heather Bissett, the manager of corporate affairs for Pfizer Canada Inc., says the FDA guidance will not impact Pfizer’s social media activities. Pfizer Canada launched its own twitter handle (@PfizerCA) to differentiate itself from the American branding (@Pfizer). While it has a modest amount of followers

The problem is that the FDA is not going to accept the excuse that we tried to do what you had in your guidance . . . They are not going

to accept that excuse

speeding is OK. They are not going to accept that excuse and as marketers we know that we can’t rely on the site links. So in essence we are back to where we were with search engine marketing, which is reminder ads and health seeking ads,” said Einarsen.

CANADA’S CAME FIRST

For tips on character space limitation social media, the US pharmaceutical companies can look

compared to its American partner, Bissett says they have been pleased with its growth.

Aware of the PAAB code regulations from its inception, the Canadian Pfizer Twitter account has been used to promote Pfizer Canada’s philanthropy projects and to create communities about similar health related concerns.

As partners with the Canadian Paralympics they have highlighted athletes, they have

discussed other partners such as Lets Talk Science, promoted their EpiPen Facebook group that is a community for people with allergies, and they Tweeted about their contest “Start Something with Alesse.”

A sample Tweet from @PfizerCA: “Support #mentalhealth; attend @Psychology_Fdn‘s 10th Annual Breakfast on November 18th http://ow.ly/CaoYJ” “Health Canada, around advertising of pharmaceutical products, limits us to name, price, and quantity of the drug, so the conversation would be pretty limited,” says Bissett.

“Instead, we are trying to provide value added and ultimately create brand loyalty. It is about creating communities around similar interests and sharing information that is of value to Canadians to help them on their health care journey.”

Bissett says the focus of their Twitter feed is to help patients take their health into their own hands and help guide conversations they can have with their physician. While she admits that it has been difficult to generate conversations through Twitter she has found they have been well re-Tweeted and favourited.

She said before launching they prepared for any scenario of how followers would interact with the company’s Twitter page—i.e, asking about products or complaints—though the conversations have remained in the realm of health communities and philanthropy.

8 · November 30, 2015

The Chronicle of Healthcare Marketing

Canadian pharma industry will show growth through 2019 continued from page 1

the Hepatitis C market. Three medications for Hep C—Sovaldi, Galexos, and Harvoni—accounted for more than $200-million in sales in this market sector last year.

LAUNCHES ON HORIZON

“There is evidence to show we will see a plateau on the private

plan side before very long,” Brogan said of the Hep C market. “But on the public plan things are just getting started.

This will be a strong contributor to growth next year and at an even higher rate than we saw in 2014.”

In the years ahead the Canadian market will also feel

the impact of new drugs entering from the global pipeline.

Last year, close to 200 medications had been pre-registered and were expected to be launched somewhere, sometime this year.

The list includes 23 antiinfectives and antivirals, 19 CNS medications and 18 oncology

agents.

Another 462 drugs were in Phase III trials for possible launches in 2017 while 1,423 NCEs were undergoing Phase II investigations for possible market entry in 2018.

“No one can forecast exactly which molecules will reach market in Canada,” Brogan noted,

“nor at which price they will launch at, nor how successful they will be at sales.”

A large, still unanswered question in the Canadian pharma market, he said, is the potential effect of biosimilar sales, particularly for rheumatoid arthritis.

What roles will payers play? What will be the impact of substitutions? What about price, and other considerations?

PATIENT PAYS DIFFERENCE

Quebec’s announced policy provides a hint of one possibility.

“The province will pay the value of the biosimilar—the lower cost—and if the patient wishes to purchase the originator, they’re going to be responsible for the extra cost,” Brogan said.

Brand erosion was a continuing phenomenon of the market last year as it was previously, but apparently occurred at a slower rate when sales rates are compared with those of older molecules and those introduced in 2011 and 2013.

Nevertheless, the number of brand prescriptions written by health care professionals last year rose by 0.9 per cent to more than 200 million, compared to the volume of fewer than 100 million in 2013. More scripts were written for generic products, but their percentage of growth fell.

“We see the (market) growth in Canada stabilizing somewhere around five per cent in 2019,” Brogan said of the years ahead.

“On the generic side, there will still be low growth. Price adjustments are still with us going forward and this is going to overhang generic growth.”

Digital devices: Many purchased, but few used much more than infrequently

—continued from page 6 Dr. Graeme Moffat, research fellow at InteraXon, Toronto, which manufactures “Muse,” a brain scanning device, echoed Follett’s comment about the revolutionary advent and impact of digital wearables.

More technologic research, the pace of introductions for new wearables and their new applications for diseases and conditions like ADHD are accelerating, he agreed, even inside a regulatory environment. They are becoming a ‘must have.’

“You can imagine that we’re moving closer and closer to things that really encroach on traditional medical markets,” he said.

November 30, 2015 · 9

The Chronicle of Healthcare Marketing

2015: Political impact will be greater than financial Prospects for growth

n Patient access to new medications will continue to be an issue for cash-strapped provincial governments

G

By Ian J.S. Moore, of THE

CHRONICLE OF HEALTHCARE MARKETING

LOBAL GROWTH MAY BE

creeping ahead at a snail’s pace—at 1.9 to two per cent, the Conference Board predicted earlier this year—but the biggest impact on Canadian pharmas next year will be political, not financial, according to an industry consultant.

“The provincial governments are all looking to control growth, in a large part because of the federal transfer, “ William Dempster, CEO of 3Sixty Public Affairs told last spring’s PharmaFocus 2019 meeting in Toronto.

Dempster noted that growth of the federal per-capita health spending transfer to the provinces will remain at three per cent next year and be fixed at that rate until 2020. It will rise only if the national economy grows above three per cent.

The economic and financial squeeze on both public and private players will also have a strong influence on pharmas’ budgets, Dempster said.

“Only around 10 per cent of Canadians list the health issue as their most important issue,” he said, citing a recent Nanos poll which found jobs and the economy to be the biggest concerns for most of the population.

LOW RATE OF BUDGET GROWTH

And he didn’t think this attitude would change any time soon, despite some loud scattered voices calling for a national pharmacare program.

“Canadians want a planned economy,” he said. “From our perspective, their votes, in most cases, won’t be earned in the [federal election] or other elections by a government that’s going to make major changes or implement national pharmacare.”

Although Dempster didn’t expect a national drug program to be an issue in provincial elections this year, pharmas can expect provincial health programs to be expanded in some way, and have an impact on their operations.

“All [provincial] health budgets are going to continue to grow, “he said, “but at very low rates.

“The 2.1 per cent increase does not support population growth in Canada, which is about one per cent a year, and inflation.

“Effectively, we as Canadians are spending less on healthcare every year.”

The implication of this for

the industry and government is that cost effectiveness is no longer the big issue. The overriding question mark is affordability.

Can governments afford to spend more through on an incremental budgetary increase basis on individual line items?

“Even efficient health spenders, and that includes British Columbia, Ontario and Quebec, are trying to cut even more or to cap spending in health care,” he said, stopping short of predicting what may be ahead on provincial budgetary line items.

Spending on medications last year rose a paltry 0.8 per cent, the fourth consecutive year this amount was lower than the annual increase in total healthcare spending, Gerry Jeffcott, Dempster’s senior associate at 3Sixty Public Affair, reported.

Public payers accounted for approximately 42 per cent of this spending total while private payers and individuals contributed the remainder.

“It is worthwhile to note that out-of-pocket spending has been growing considerably,” he said. “It’s hard to assess what that consists of, but we suspect a portion may be covered by pharmas’ patient assistance programs.”

Jeffcott pointed to the larger use of generics and the provincial governments’ pricing policies on medications as the driving forces affecting the medication growth trend. And recent events suggest generics will continue to gain sales in Canada. “[The provincial govern-

ments] really are attempting to usher in this mindset of moderate growth in the pharmaceutical budget area,” Jeffcott remarked.

He identified a number of factors and trends affecting the industry this year—some still in play beyond 2015—including patient access to new medications, HTA reviews and national pharmacare.

PATIENT PAYS DIFFERENCE

“Lots of dialogue , but we don’t anticipate actual action on national pharmacare,” he said.

“It’s unclear exactly what it’s going to look like, but advocates out there are actively promoting national, universal, first-dollar coverage à la Medicare program.”

Orphan medications, he noted, will also receive attention.

Promised for a number of years now, the federal regulatory framework is still awaited, expected,, while HTA (the public health review agency) and the provincial governments will continue their advocacy around the issue of reimbursement for these medications.

“It’s clear from Quebec’s experience, they are looking for savings and preferential listings as a way to force prices down or to force the innovator into negotiations,” Jeffcott said of another pharma trend, SEB medications and pricing.

The PMPRB want to become more “active and relevant” he added, in response to

pressures from private payers and the provinces, especially because of the pCPA. framework.

“Health Canada is going to spend a lot of time over the next few years, implementing its progressive licensing approach to medication review,” he said, referring to the recent passage of Bill C-17.

“And, of course, there’s a raft of regulations, updates and policies that are going to be associated with getting the benefits of that legislation to the fore.”

National reforms of health policy are now propelled by the provinces, Jeffcott concluded, and this trend is likely to continue because the federal government is apparently content with a back seat role.

Best school team in Gutsy Walk

The Queen’s University chapter of Crohn’s and Colitis Canada in Kingston, Ont., took home the best school team during the Gutsy Walk research fund- and awareness-raising event for chronic inflammatory bowel disease. (Crohn’s and Colitis Canada)

10 · November 30, 2015

The Chronicle of Healthcare Marketing

Biosimilars not considered true generic biologics by Health Canada

continued from page 1

ity—but not ‘identicalness’— similarity to a referenced biologic drug.”

GUIDELINES VERY GENERAL

Health Canada also does not consider biosimilars to be generic biologics, because, unlike generic drugs, which are copies of synthetic chemical drugs, it is virtually impossible to manufacture a

biosimilar which is identical to the original biologic medication.

Health Canada has guidelines for companies to manufacture SEBs in this country, she said, but the guidelines are very general, not specific. “They say, ‘You know what? You need some manufacturing data, you need some animal data and you need some clinical data. Go take a look at the ICH guidelines.

“It really doesn’t tell you very much more than that.”

The guidelines in Europe are more general, she said, regulating by type of medication (e.g. monoclonal antibodies, insulin derivative, a second biosimilar). “In Canada and the United States, we don’t have that depth of guidance.”

There is no legal process in Canada for SEBs, in contrast to the regulations obliging generic

drug manufacturers to file an abbreviated new drug submission. A SEB in this country is a new drug submission (NDS).

Typically, generic products are reviewed in Health Canada by the Therapeutic Products Directorate, and subsequent entry biologics by BGTD, the biologics and genetic therapies directorate.

According to Tomalin, information about SEBs in this

country is scanty. As of 2012, five new drug submissions had been filed for SEBs; one SEB from Sandoz had been approved in 2009 before any guidelines were introduced.

Another SEB—this one from Teva—was under review in 2012, and has yet to be approved.

One SEB was approved last January and two NOCs were issued for the same product (infliximab biosimilar) in the same submission.

“As of two years ago Health Canada had also scheduled eight pre-NDS meetings on biosimilars,” Tomalin revealed. “They may have been related to the five products that were submitted, or they may have been different.

“So, as of two years ago, we know that somewhere between eight and 13 subsequent entry biologics had been filed in Canada.”

And, as of last October, none of the patents for these products had been litigated.

MUST BE SIMILAR TO REFERENCE PRODUCT

Regulations are different in other jurisdictions, Tomalin said. The Biologics Price Competition and Innovation Act in the United States established an abbreviated licensing pathway for biosimilars in 2009, but by Sept. 2014, no biosimilar had been approved through this legislated process.

The Act also introduced the new 351K application submission, which requires pharmas to demonstrate their product is similar to a reference product: the same mode of action was used to achieve the same previously approved indications, the same route of administration, the same dosage form, the same strength as the reference product.

“If you submit such an application,” Tomalin said, “the FDA decides whether the quality of the application is good enough to accept the filing.

Given that you get an acceptance, within 20 days, you’re required to give all of your manufacturing data to the innovator so it can review what you’ve done to determine if patent litigation shoul be instituted.”

Meanwhile, 17 INDs have been filed and the FDA is meeting pharmas to discuss the development of biosimilar products.

Of the 76 meetings requested— the agency requires fees— approximately 60 had taken place by last October.

According to Tomalin, the FDA has also issued draft guidelines on biosimilars and holding meetings with the agency.

“Like Canada, [these are] very general guidances. Not specific, and not going to help you on a product-by-product basis.”

November 30, 2015 · 11

The Chronicle of Healthcare Marketing

Report on agencies: Looking at clients as partners is new reality

—continued from page 4

need a partner they can rely on,” Cran says. Brand teams can leverage an agency’s knowledge of various markets and how to be successful in those markets.

“So, if they do get a product to launch, they’d better pick an agency that’s been to the same show a few times.”

MORE WORK, BUT FEWER PHARMA EMPLOYEES TO DO IT

A major factor within the industry, Cran adds in echo to the comments of other commentators, is that there are fewer people employed by pharma to carry out the company’s operations.

“When it comes to experience their resources are diminished. Typically, today the agency has more experience launching brands.”

Much ballyhooed and highly regarded in the past, ‘creative’ is not as creative in 2015, according to Cran.

“Good creative has gone away.”

Today, the usual procedure is to have new concepts developed by a unit close to company head office, then shipped to various pharma branches for revision and adaptation to fall in line with the government’s rules and regs for marketing medications.

“It’s very generic looking. It doesn’t have bite.”

A former vee-pee of marketing at a major pharma and now a senior partner at Toc Toc Communications, Montreal, Arnaud Lavenue is not completely on board with this approach. He says pharmas may be making a mistake if they choose as agency partners outfits whose niche of expertise is exclusively the pharmaceutical industry.

Pharmas would enjoy a greater benefit if they adopted some of the business strategies and tactics of other industries, such as packaged goods. And agencies would be a lot more useful to their clients if they stepped beyond the traditional representation of a group of medical writers, account executives, digital specialists and other experts working as a team.

“You need to be strategic in your execution,” Lavenue says of agencies. “You need to move from pure promo and advertising, and as an agency understand your client’s culture and corporate structure, their principal market—physicians—and all the other client stakeholders along the way.”

The pervasiveness of the digital universe is likely the main reason pharma clients expect more from their agencies today, according to Miriam Hara, chief creative officer at 3H

Communications in Oakville, Ont. “The expectations about turnaround are faster and faster,” she says. “And to get new clients, maintain the ones you now have, you always have to go beyond You expectations. can’t be complacent, assuming an existing relationship will continue.”

In many cases, she notes, relationships are shorter because of changes in personnel numbers and personalities.

“You have to be nimble,” she advises.

“You have to be flexible, you have to be adaptable. And you have to provide value.

You always have to provide value.”

The key, Hara believes, is continuous feedback. The agency-client association has always relied on this and a principal job for the agency is to maintain this solid bonding.

“This doesn’t mean you get it right all the time,” she says, stressing the necessity of an agency’s willingness and openness also applies to the other side.

“We’re not vendors or suppliers. We’re partners.”

CHRONICLE OF HEALTHCARE MARKETING. The job demands that he or she now has to do a little bit of everything.

“The jobs that were eliminated after M&As were the training grounds for product man-

“A bigger partnership role, more responsibility. That’s the agency description today.”

LEARN TO DO MORE WITH LESS

Renée Lagacé, owner and managing director of Healthwise Creative Resource Group in

more from their agencies today than they did in 2000. “Clients are under-resourced in terms of manpower and in terms of budgets,” she says. “You have to learn to do more with less and we understand this.”

However, she does feel that there is still lots of opportunity for creativity, even if you are working with Global creative.

It’s up to the agency to figure out a way.

“When it comes to evaluating creative, it is all about collaboration and going back to the creative brief and the brand ideas that have driven the concepts,” Lagacé says. She noted there must also be an element of trust between the agency and client throughout the whole process, including the presentation and the evaluation.

“Concept and creative development is a very finely-tuned process, one that both parties usually enjoy,” she said.

“Now agencies are given a bigger partnership role, getting involved in the strategic planning effort”

PHARMA LANDSCAPE CHANGED

Christian Roy, partner and executive vee-pee for the health division at TANK in Montreal, agrees that being involved in a successful launch of a new therapy was a great way for an agency to earn and retain its reputation and reknown 10 or even five years ago.

But many regulatory and market changes during the intervening years have reshaped the pharma industry’s landscape and revised the agency-client relationship.

He agrees with James Cran that these changes have been so vast and extensive in recent years, clients are now obliged to rely more than ever before on their agencies and consultants.

“Cutting back on the client side continued during the past year,” he reports. “Brand managers and product managers are just as overwhelmed, if not more so.”

With fewer sales, marketing and product managers in their ranks today, pharmas, as they never have before, look to their agencies for these functions.

“The pharma product manager today is a bit of a one-man show,” Roy, a former vice-president at Pfizer told THE

agers, “ he says, “so now agencies are given a bigger partnership role, getting involved in the strategic planning effort.

I

Toronto, agrees with others on the agency side of the industry who say clients expect and get

Regulators continue to set their sights on the drug industry

India joins march to introduce mandatory marketing rules for pharma

t’s hardly surprising, but Indian legislators have determined that a voluntary code discouraging drugmakers from offering gifts to doctors to prescribe their products is being ignored. According to a news report, mandatory rules will soon be developed and implemented.

Though the practice of promoting to doctors has been scrutinized, limited, and banned in North America, the European Union, and other countries, the pharma industry in India is still pushing back against the concept of marketing regulation.

According to the report from the e-paper Live Mint (Sept. 29, 2015), P.K. Gupta, chair of the Confederation of Indian Pharmaceutical Industry (Cipi) said that mandatory regulations are a waste of time. “If the government wants to manage the [pharma] industry, they should implement price control measures properly. Tightening of norms should not be on the marketing side.” Government estimates predict the US$32-billion Indian pharmaceutical industry could reach US$85 billion by 2020.

n In the European Union, the Parliamentary Assembly of the Council of Europe adopted a resolution that pits the public interest against the interests of the pharmaceutical industry. It also brought into question the current state of intellectual property rights, according to a report in Intellectual Property Watch.

The Sept. 29 resolution calls on member states to apply rules to limit rising drug prices and conflicts of interest in pharma and healthcare in general. The resolution notes that while the innovation model based on the intellectual property protection of molecules developed by pharmaceutical companies has led to many therapeutic discoveries, “more and more voices are now being heard arguing that this is not the optimal approach in public health matters.”

n In a report in BioWorld Online (Oct. 22, 2015), it was reported that China’s State Council instructed the China Food and Drug Adminstration to fix the regulatory system by speeding up the time it takes for drug reviews, and to get better quality innovative drugs to market. This edict has appeared to shake up China’s pharma sector, but the message is clear: China is taking some steps to move closer to international practices in pharma and farther from its less-than-steller pharma manufacturing practices of the past.

For example, the existing drug classification system will be re-jigged and simplified and will contain only two primary categories: new drugs and generic drugs. One significant change is that new drugs will be defined as new drugs not marketed anywhere in the world, while innovative and improved new drugs will be listed in sub-categories.

12 · November 30, 2015

The Chronicle of Healthcare Marketing

NOCs of Note: November 2015

Significant TPP approvals of Rxs for human use —continued from page 3

Avastin in combination with paclitaxel, topotecan or pegylated liposomal doxorubicin is indicated for the treatment of patients with recurrent platinum-resistant epithelial, ovarian, fallopian tube or primary peritoneal cancer who received no more that two prior chemotherapy regimens. These patients should not have received prior VEGF-targeted therapy, including Avastin; 25 MG/ML, IV

HIV-1 protease inhibitor 09-25 Atazanavir sulfate/cobicistat (Evotaz, Bristol-Myers Squibb Canada) Comments: atazanavir sulfate 300 MG/TAB/cobicistat 150 MG/TAB, oral

Monoclonal antibody 09-25 Nivolumab (Opdivo, BristolMyers Squibb Canada) Comments: New drug submission, 40 MG/VIAL, 100 MG/VIAL, IV Immunomodulator 09-22

Teriflunomide (Aubagio, Genzyme Canada) Comments: Safety updated and description of a new study in action and clinical pharmacology section; 14 MG/TAB, oral

Atypical antipsychotic 09-16 Aripiprazole (Abilify Maintena, Otsuka Pharmaceutical Co. Ltd.) Comments: Expansion of indication to include treatment of acute episodes of schizophrenia; 300 MG/VIAL/KIT, 400

Comments: Extension of the indication to Intuniv XR both as monotherapy and adjunct to psychostimulants in adolescents (13 to 17 years of age); 1 MG/TAB, 2 MG/TAB, 3 MG/TAB, 4 MG/TAB, oral

MG/VIAL/KIT, 300 MG/VIAL, 400 MG/VIAL, powder for suspension and IM injection, sustained release

Retinoid-like compounds 09-16 Benzoyl peroxide/adapalene (TactuPump Plus, Galderma Canada Inc.) Comments: To add new strength and expand the indication for TactuPump Plus; benzoyl peroxide 25 MG/G/adapalene 3 MG/G, topical

Monoclonal antibody 09-10 Evolocumab (Repatha, Amgen Canada Inc.) Comments: 140 MG/ML, subcutaneous Antihypertensive 09-08 Guanfacine HCL (Intuniv XR, Shire Pharma Canada ULC)

Platelet aggregation inhibitor 09-04

Ticagrelor (Brilinta, AstraZeneca Canada Inc.) Comment: Changes to the dosage and administration section of the product monograph to allow for crushed tablets mixed in water); 90 MG/TAB, oral

Chemotherapeutic agent 09-01 Cytarabine (Cytosar, Pfizer Canada) Comments: Extension to the physical and chemical stability of cytarabine for injection (20 MG/ML) and cytarabine solution for injection (100 MG/ML) diluted to 37.5 MG/ML after first opening of product; 20 MG/VIAL, intrathecal, intravenous, subcutaneous; 100 MG/VIAL, intravenous, subcutaneous Monoclonal antibody 08-31 Panitumumab (Vectibix, Amgen Canada) Comments: Additional indication: Vectibix is indicated for the treatment of previously untreated patients with non-mutated (wild-type) RAS metastatic colorectal carciinoma (MCRC) in combination with folfox; 20 MG/ML, IV

Oral anticoagulant 08-19 Rivaroxaban (Xarelto, Bayer Inc.) Comment: Updates to the product monograph; 10 MG/TAB, 15 MG/TAB, 20 MG/TAB, oral

Tyrosine kinase inhibitor

08-19

Nilotinib hydrochloride monohydrate (Tasigna, Novartis Pharmaceuticals Canada) Comments: Fulfilment of the final post-approval commitment for the notice of compliance with conditions market authorization of Tasigna for use in patients with newly diagnosed Philadelphia chromosome positive chronic myeloid leukemia (PH+CMA) in chronic phase; 150 MG/CAP, 200 MG/CAP, oral

Antiepileptic 08-17 Vigabatrin (Sabril, Lundbeck LLC) Comments: Safety updates throughout the product monograph; 500 MG/PCK powder; 500 MG/TAB

Antineoplastic agent, pyrimidine analogue 08-14 Azacitidine (Vidaza, Celgene Inc.) Comments: Update to the warnings and precautions, dosage and administration and action and clinical pharmacology sections of the product monograph with data from a renal impairment study; 100 MG/VIAL, powder for suspension Antiviral agent 08-13 Daclatasvir (Daklinza, BristolMyers Squibb Canada) Comments: 30 MG/TAB, 60 MG/TAB, oral

November 30, 2015 · 13

The Chronicle of Healthcare Marketing

significantly improved revenue we are beginning to HLS THERAPEUTICS of Toronto, a new specialty Rx Up Here receive as a result of HORIZON’s success in sellmarketer, bought Canadian and USA rights to What’s happening in the world of drug marketing ing Pennsaid 2% in the U.S. and the opportunity antipsychotic clozapine (Clozaril, NOVARTIS.) to make Pennsaid 2% a global brand through Company CEO Greg Gubitz says he plans to buy in its Phase I/II clinical study of EPI-506, for Tx of international out-licensing or other monetization strateNorth American rights to more legacy CNS products. Adds metastatic castration-resistant prostate Ca (CRPC) in gies.” In a separate development, the company tapped executive chair Bill Wells: “We are also extremely pleased to patients who have failed current therapies. Says chief scisee the support from our investors for HLS and our vision ence officer Dr. Marianne Sadar: “The novel mechanism of Samira Sakhia as a director. She was CFO of Paladin Labs for 14 years. for Clozaril as our foundational product to build on.... We action of EPI-506 holds potential to successfully treat are actively pursuing additional products.” According to a prostate cancer patients who have failed existing therapies.”

CARDIOME PHARMA of Vancouver says its subsidiary, company statement, the HLS management team led Correvio International, entered into an exclusive license NUVO RESEARCH of Mississauga, Ont. Biovail’s merger with Valeant Pharmaceuticals in 2010. and supply agreement with EDDINGPHARM to Yves Bastien, ex-CEO of Sanofi, is an HLS board member. says it plans to split into two separate pubdistribute and commercialize tirofibanin licly traded companies. According to Health Canada green lighted carglumic acid (Carbaglu, (Aggrastat) in China. Financial terms were not prexy and co-CEO John London, one ORPHAN EUROPE) as adjunctive Tx for acute hyperamdisclosed. Cardiome also says Dr. Robert entity will focus on specialty pharma, monemia and maintenance Tx for chronic hyperammonemia and the other on Rx development. Says James Meyer has signed on as a director. due to the deficiency of the hepatic enzyme N-aceytlglutaHe has worked at Merck Research he: “We believe this is the right time to mate synthase (NAGS) in pediatric and adult patients. The Laboratories and the U.S. FDA. separate the businesses because of the Rx will be imported and distributed in Canada by RECORDATI RARE DISEASES. Milan-based Recordati also owns Orphan Europe.

ESSA PHARMA, the Vancouver Rx developer, says Health Canada HPB issued a no-objection letter that will allow Canadian sites to be included

Disorganized system powerful argument for pharmacare —continued from page 14

Provincial governments wield about $10 billion in purchasing power when negotiating rebates for prescription drugs.

This reduces public drug plan costs by millions of dollars. But it does not lower costs for cities and other organizations which insure their workers through the private drug plans that are miniscule in comparison.

No matter how hard they try, cities would have about as much chance of negotiating competitive drug prices as homeowners would have of securing the best prices for infrastructure planning, engineering and construction.

Some things are best done through well-planned, population-level procurement processes.

A recent study in the Canadian Medical Association Journal shows how a universal public drug plan run by provinces could provide all Canadians coverage for prescription drugs while saving taxpayers $7 billion per year.

Such a program would end the downloading of prescription drug costs to local governments and thereby allow cities to better address problems like traffic, housing and crime.

The federal and provincial governments should take responsibility for our prescription drug problem by implementing universal pharmacare for all Canadians.

Doing so would support the health and wellbeing of public and private sector workers alike at far lower cost than Canadians are paying for our disorganized, patchwork system today.

Steve Morgan is an expert adviser with EvidenceNetwork.ca and professor and Professor of Health Policy at the University of British Columbia School of Population and Public Health in Vancouver. © 2015 Distributed by Troy Media.

CCPE CLASS OF MEDALISTS June 2014 to May 2015 AccreditaƟon (GOLD)

Gabriel Douville

Paladin Labs

AccreditaƟon (SILVER)

Lisa Range

Boehringer Ingelheim

AccreditaƟon (BRONZE)

Alyssa Den Heyer

Servier Canada

Biosimilars in Canada

Tara Brohman Danielle Deslauriers Alain Giroux Susan Guchardi

AbbVie Merck Eli Lilly Canada Merck

Cardiology

Shannon Bradford Kylie Brandon

Servier Canada Boehringer Ingelheim

ConƟnuing Health EducaƟon (CHE)

Jascha-Nikolai Rybak

Hoīmann-La Roche

Dermatology

Pavel Goldvasser

Boehringer Ingelheim

Endocrinology

Sarah Arendse

Janssen Inc.

Engage Rx: The 3 Keys to PaƟent-Focused Growth Pauline Caza Vicki Ifill for Pharma Professionals Susan Legge Angela Mohan Donnalea Racco

Bayer Inc. Bayer Inc. Leo Pharma Bayer Inc. Purdue Pharma

Evidence-Based Medicine

Shaheer Bhaidani

Purdue Pharma

Field Sales Management

Ioana Modroiu

Purdue Pharma

Gastroenterology

Jodi Dubnyk

Takeda Canada

Gerontology

Courtney Jeīery

Purdue Pharma

Healthcare In Canada

Anne-Marie Rivard

Hoīmann-La Roche

Immunology

PaƩy Keigan

AbbVie

InfecƟous Diseases

Josée Boulianne

Astellas Pharma

Managing People

Sara BeaƩy

Purdue Pharma

Metabolic Syndrome & Diabetes

Erin Fraser

Boehringer Ingelheim

Neurology

Douglas Graham

Associate Member

Persuasion Rx: How to Influence Ethically

Sarah Petrari Gavin Risi

Pfizer Consumer HC Associate Member

PharmaceuƟcal Market Access in Canada

Hope Gouthro

Novo Nordisk

Pharmacoeconomics

Patricia Addley

Purdue Pharma

Psychiatry

Mireille Marceau

Purdue Pharma

Respirology

Tyler Huether

NovarƟs Pharma

Rheumatology

Julia Quigg

Associate Member

Women’s Health

Courtney Jeīery

Purdue Pharma

EducaƟon, AccreditaƟon, Professional Ethics

www.ccpe-cfpc.org

14 · November 30, 2015

The Chronicle of Healthcare Marketing

Shunning Shkreli: Go Ahead and Loathe the Most Hated Man in Pharma (But Only If You’ve Never Shkrelied)

I

T TAKES A SPECIAL JE NE SE QUOIS TO STAND OUT AS THE WORLD’S MOST UNPOPULAR PHAR-

maceutical executive. It requires more than simply being the worst-behaved child in the detention room, or having the longest fork in the all-you-can-eat buffet line, or possessing the thickest expense-claims file in the Canadian Senate.

It is no small achievement to lay claim to the title of Ultimate Despised Figure in the one business the public most loves to hate: to gain status as, in the critics’ view, the smelliest varmint in the skunkworks.

What does it mean to be worst of the worst? True to typical CEO form, some of the economy’s most successful leaders are known to rankle. (Look, you can’t please everyone.)

Others drive harder, and become magnets for hostility. (When you cook an omelet, you need to break a few eggs, friend-o.)

That said, there is nothing—but nothing—to prepare anyone for Martin Shkreli.

Mr. Shkreli is the founder of Turing Pharmaceuticals, although it would be wrong to assume that he follows any previously known tradition of drug company entrepreneurship.

After all, Dr. Paul Janssen founded a drug company, and became revered. Abe Plough started his company and won respect. No one is ever going to confuse Martin Shkreli with Dr. Janssen or Mr. Plough.

Mr. Shkreli is a Millennial, but hardly the sort found living on a futon in his mom’s garage. At 32 years of age, he has been a Wall Street macher for nearly half his life, having learned the trade of hedge fund management early on from mentors such as Jim Cramer, the famed stock-trader/TV presenter. Turing is already the second Life Sciences company Mr. Shkreli has created in four years, after Retrophin Inc. (More about those two organizations in a moment.)

Where Dr. Janssen made his reputation by creating therapies and Mr. Plough by selling them, such fusty, labour-intensive activities are anathema to Mr. Shkreli. He is the kind of opportunistic businessman who will spot and pursue situations that the traditionalist might be inclined to dismiss.

For example, five years ago, he perfected what we will call the Shkreli Shuffle, a proudly brazNovember 30, 2015 • www.pharmacongress.info en moneyPUBLISHER making gamMitchell Shannon bit previously uncommon in the annals of EDITORIAL DIRECTOR SALES & MARKETING Life Sci finR. Allan Ryan Sandi Leckie ance. In this SENIOR EDITOR PRODUCTION & CIRCULATION Lynn Bradshaw Cathy Dusome unique proceASSOCIATE EDITORS COMPTROLLER dure, Mr. John Evans Rose Arciero Shkreli filed Emily Innes Published four times annually by the proprietor, Chronicle Information Resources Ltd., from offices at 555 Burnhamthorpe Rd., Suite 306, Toronto, Ont. M9C 2Y3 Canada. Telephone: 416.916.2476; Fax 416.352.6199.

E-mail: health@chronicle.org

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THE CHRONICLE OF HEALTHCARE MARKETING welcomes contributions from readers. In particular, we’d like to know what’s going on at your company, or organization, and you are especially welcome to keep us informed about new developments, new appointments, and new practices at your shop.

If you’re submitting an article, opinion piece, press release, or letter to the editor for consideration, please bear in mind that we select material for publication from a large volume of submitted material, and that we may not be able to publish your submission in a specific issue (or at all) due to space constraints and other considerations.

Our policies are: All material submitted to THE CHRONICLE becomes the property of Chronicle Information Resources Ltd., and is subject to the company’s usual editorial procedures; We will not consider for publication any material that has been simultaneously sent to other publications; Only original material or information will be considered; Payment at our established freelance rates will be offered upon publication for feature articles and for the following departments: What Lies Ahead: Original articles of approximately 500 to 700 words dealing with trends that shape the healthcare industry; and My Turn: Opinion pieces of approximately 500 to 700 words, offering original commentary on issues facing the healthcare industry.

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statements with the U.S. FDA urging the regulator to reject a new diabetes treatment, and a cancer detection test, apparently for the sole purpose of driving down the share price of the two publicly traded companies tasked with commercializing the wares. His investment house used the lull to short-sell the stocks. This was no service to patients who may have benefited from the timely availability of the products, or to the companies and their investors who suffered financial reverses from the delay. Conversely, Mr. Shkreli and his trusty balance-sheet made out just fine.

No one questions the man’s acumen—although several are investigating his compliance with securities laws. His first company, Retrophin, is suing his subsequent outfit, Turing, alleging trading violations; federal attorneys are reportedly contemplating charges.

Undaunted, Turing made headlines recently after buying the rights to pyrimethamine (Daraprim) from Impax Laboratories. The Rx is a warhorse used since 1952 to treat toxoplasmosis, cancer and AIDS, but Mr. Shkreli aimed to price it like a new biologic, quickly lifting the retail price to US$750 per dose, from US$13.50. Of course, various other drug companies have been quietly raising prices on older medicines for several years, to the accompaniment of muted grumbling from stakeholders. No whispered resentment this time. Nothing about Mr. Shkreli is ever destined to elicit a quiet response.

Patient groups raged at the news. Politicians railed. Chanting protesters encircled the Turing headquarters, equipped with placards. Social media commentators pilloried Mr. Shkreli, who unwisely responded with his own profane Twitter invective. In the process, the entire pharmaceutical and biotech sector was sullied, leading to Turing’s expulsion from the major trade groups, a sharp decline in the benchmark share price index of the entire drugmaking category, and new hearings about pricing, soon to be conducted by the United States Congress.

Pharma has never been a beloved industry among the public, but Mr. Shkreli has found himself tagged as the embodiment of each of his predecessors’ and competitors’ past and current sins. As a parvenu and a Wall Street guy new to the ways of the life sciences environment, he is not at all well positioned to contextualize, and his clumsy efforts to explain things have brought considerable disrepute and discredit to the biopharma industry and all within its orbit. Quoth he: “Dozens of drug companies have done what I've done.”

No, Mr. Shkreli. No, they haven’t.

It’s too easy to further demonize this fellow (not least because he physically resembles the actor who played Damien in the 1976 film, “The Omen.”) Thing is, if his flawed understanding, near-complete lack of judgment and unfortunate personality had not lit the fuse, another drug company executive likely would have been cast in the role of cartoon-villain.

And when certain business practices relating to supply and pricing are indefensibly crude and ill-considered, it seems convenient to have a prima facie miscreant, a fraternity-brother approximation of J.R. Ewing, to serve in the capacity of human lightning rod.

That may be the logic behind PhRMA’s unprecedented disavowal of Turing, and BIO’s abruptly having tossed the company from its membership roster. More practically, though, they and we must owe a small measure of gratitude to Mr. Shkreli for his foolhardy pricing model, which served to define the outer limits of responsible behaviour by capitalists who make and sell medicine.

By rushing to undertake patently unacceptable actions, he has inadvertently performed a roundabout service to his industry peers, by encouraging each of us to assess and purge our more Shkreli-like impulses, and to come to terms with that unworthy inner voice that sometimes whispers dangerous entreaties. His contribution to our cause is as negative rolemodel, instructing us to disregard the little Shkreli that might sometimes stir inside the best of us.

Opinions expressed are solely the editorial judgment of this publication, and do not represent any other views. Rebuttals and comments are invited. Write to: health@chronicle.org

My Turn

Canada’s $500-million drug problem

C

By Steve Morgan,

Special to THE CHRONICLE

OF

HEALTHCARE MARKETING

ANADA’S CITIES FACE A NUMBER OF PROBLEMS, INCLUDING TRAFFIC CONGESTION, HOUSING COSTS, CRIME

rates and shabby infrastructure. Now prescription drugs can be added to the list; it is a problem that is costing local governments as much as $500 million every year.

Recognizing that access to necessary medicines is critical for health and wellbeing, many cities offer their employees private insurance coverage for prescription drug costs. For example, the cities of Toronto and Calgary spend approximately $43 million and $20 million, respectively, on private drug insurance plans for their employees.

The coverage they offer is relatively comprehensive, resulting in costs per employee that are equal to private sector averages. Vancouver and Halifax offer less comprehensive drug coverage for their employees but still at considerable cost—about $3 million each.

There are more than 600,000 local government employees across the country, according to Statistics Canada, and two-thirds of them receive private health insurance from the cities, towns and districts they work for. Based on the cost of such coverage for the four cities mentioned, it is a reasonable estimate that local governments are spending $500 million a year on private drug insurance for their employees.

Cities have to spend this money—taken from local taxpayers—because Canada’s medicare system is the only universal, public healthcare system among developed countries that does not include universal coverage of prescription drugs.

PATTERN IS COSTLY

It is not wrong for cities to care for their employees. But leaving these costs to the cities makes about as much sense as requiring every homeowner to maintain the roads and infrastructure surrounding their property. Just as would happen if infrastructure was left to individual homeowners, the system that leaves drug coverage to individual patients and employers—including cities—creates an uncoordinated patchwork. Most cities provide coverage, but some can’t afford to. Some workers qualify for coverage, but some don’t.

The same pattern plays out in cities, hospitals, schools and businesses across the country. As a result, millions of Canadians are without drug coverage and one in 10 Canadians cannot afford to fill their prescriptions.

This patchwork is inequitable and profoundly inefficient because it fails to place responsibility for drug coverage and costs with the right level of government.

Provinces and the federal government are responsible for Canada’s healthcare system. They are best suited to manage access to medicines as an integral part of healthcare for all Canadians. They are also best positioned to reduce waste and overspending on pharmaceuticals.

Having multiple drug plans operating in every province—including multiple private plans for public sector employees—needlessly duplicates administrative costs. This fragmentation also diminishes Canadians’ purchasing power on the global market for pharmaceuticals.

Turn to Disorganized system, page 13à

360° Dermatology It’s not just content. It’s engagement.

Should laser removal of tattoos be performed only by physicians?

Clinical practice

The Chronicle

of

SKIN SKIN

&

ALLERGY

Some techniques may be safer in the hands of physicians, observers report

Cosmetic Dermatology I

J U N E 2015

New fillers offer advancements

See page 4

PASI 90 or 100 new endpoints in management of psoriasis Clinical practice

Assistant Editor, The Chronicle

Therapies raising patient expectations regarding treatment outcomes

A

by LOUISE GAGNON,

Correspondent, The Chronicle

t the most recent annual meeting of the American Academy of Dermatology in San Francisco, data on the newest therapies to treat chronic plaque psoriasis revealed one certainty—that the demonstrated efficacy of these treatments will raise patient expectations to a level that has never before been seen. “We are now talking about [endpoints like] PASI 90 or PASI

100,� said Dr. Charles Lynde, medical director at the Lynde Institute for Dermatology in Markham, Ont., and associate professor in the Department of Medicine at the University of Toronto. “One of the most exciting things [revealed at the AAD] is the introduction of the data on the [anti] IL-17 agents.�

Different pathways assessed Secukinumab (which has been approved for chronic, plaque psoriasis in Canada and the U.S.),

New alternatives to long-term use of hydroquinone in melasma Pigment disorders

C

Kojic acid, azelaic acid, adapalene useful

by LOUISE GAGNON, Correspondent, The Chronicle

linicians can consider using topical therapies such as kojic acid, azelaic acid and adapalene as alternatives to prolonged use of hydroquinone for melasma, says a professor in the Department of Dermatology at Maulana Azad Medical College and Lok Nayak Hospital in New Delhi, India.

One of several dermatologists speaking in San Francisco at the Please turn to Melasma page 32 annual meeting of the

brodalumab, and ixekizumab, will all be “game changers� in the management of the condition, says Dr. Lynde. “This is a different pathway,� said Dr. Lynde. “It seems to be more specific and has Dr. Charles Lynde very high efficacy and higher efficacy than other biologics that we have.

We can see from the data, that they are all quite safe.�

Recently released results point to Please turn to PASI 90 page 12

n a recent news article published online in the Canadian Medical Association Journal (Apr. 13, 2015), Canadian Dermatology Association president Dr. David Zloty said that the CDA would prefer if all directed-energy dermatology devices, including tattoo-removal laser systems, were operated exclusively by physicians or physician-designated staff. However, there are arguments both for and against making laser tattoo removal a restricted medical procedure, according to two Canadian dermatologists who spoke with THE CHRONICLE OF SKIN & ALLERGY.

powered by

1

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Keynote lecture

by Dr. John McGrath to discuss genetic technologies

by EMILY INNES for skindaily

Galas, Events, Social

Ceremonies: Vancouver

Police Pipe Band among wide range of social activities during your week at the 23rd World Congress

Dr. Jerry Shapiro (l), and Dr. Harvey Lui (r)

GENODERMATOSES: Discoveries will lead to better and targeted therapies

VA N C O U V E R —A professor of molecular dermatology at King’s College London will be encourag-

ing dermatologists to embrace new technologies in genetics during his keynote lecture on Tuesday, June 9.

Dr. John McGrath says as a result of new genetic technology the days of not having an explanation for a genetic condition are quickly becoming history. Clinicians now have the opportunity to conduct tests to determine a patient’s particular mutation, which can lead to better and tar-

5 more reasons

to be glad you’re in Vancouver today

1

17

15

7 am tomorrow:

Pearls

on Atopic Der matitis

on systemic

Presentation

therapy by Dr. Sandipan

Dhar of India to take place

Tuesday

morning

Genodermatoses “In a time, [clinicians] are very short going to have to get up to speed and familiar with genetic information,� warns Dr. John McGrath. “It is coming and it is coming in bucket loads.�

Skin

VA N C O U V E R —On behalf of the Canadian Dermatology Assoand

the WCD

ciation (CDA) 2015 National

Organizing Com

mittee, we are delighted to extend a warm welcome to beautiful Vancouver and the 23rd

ILDS World Health Day Will the 23rd WCD lead to a concrete plan? Dr. Jean Bolognia hopes so

A message from Dr. Jerry Shapiro, President, and Dr. Harvey Lui, Secretary-General

3

skinchronicle international

www.

derm. city

Info on the go

Get hourly World Congress news updates via Twitter, plus daily podcasts, images and video reports sent directly to your mobile device. Only at

www.derm.city “Where Dermatology lives�

from WCD National Organizing Committee

June 8 2015

Please turn to Tattoo page 14

D ERMATOLOGY

Monday WELCOME TO VANCOUVER: Greetings

In favour Strongly agreeing with Dr. Zloty that laser tattoo removal should be a restricted procedure, dermatologist Dr. Lisa Kellett of Toronto says that formal medical training is needed to adequately assess and screen candiDr. Lisa Kellett dates before laser tattoo removal. “There are people who would not be good candidates for the procedure,� says Dr. Kellett. “If you have had an allergic reaction to the ink, there is a chance that by lasering the ink you can actually have an anaphylactic reaction,

which is potentially life-threatening.�

As well, she says, if a patient has a

in cancerous or pre-cancerous lesion

the tattooed area that has not been

identified, the tattoo-removal proce

I The Chronicle is committed to maintaining leadership in environmentally sustainable policies, and to encouraging the adoption of “green-aware� practices in healthcare. We invite your comments via e-mail, at: health@chronicle.org

OF

skindaily

I

by JOHN EVANS,

Image courtesy Vanessa Tevesti (cc) Creative Commons

All rights reserved. Chronicle Information Resources Ltd. Canada Post Canadian Publications Mail Sales Product Agreement Number 40016917

P RACTICAL T HERAPEUTICS and C LINICAL N EWS from the W ORLD of D ERMATOLOGY

OFFICIAL NEWSPAPER OF THE 23 RD W ORLD C ONGRESS

Vancouver Art Gallery: Well-known for its collection of Emily Carr paintings, sketches, and ceramics, the gallery also

houses superior collections of photographs by Ansel Adams, Cindy Sherman and Henri Cartier-Bresson. A current exhibition is the Architecture of Herzog and de Meuren. www.vanartgallery.bc.ca

2

Punjabi Market. Not really a market but a neighborhood of continued on page 17 shops and restaurants that

geted therapies. “Dermatologists should incorporate genetics into their professional lives with some enthusiasm rather than with some despair,� says Dr. McGrath, head of King’s College London’s Genetic Skin Disease Unit. “Those days of ignorance and not being able to do anything [for patients] are passing. Now there are some very real, here and now, [actions] that we can take in terms of diagnosis and counselling and, before too long, deliver better therapies.

It is a changing world for dermatology and genetics.�

MORE ACCURATE DX Technology called whole exome sequencing, part of next generation gene sequencing, allows clinicians to make more accurate diagnoses for patients with rare but also common conditions, such as eczema and psoriasis.

Next generation gene sequencing is a routine blood test, but the challenge is understanding the genetic information on the report, says Dr. McGrath. While he says modern-day dermatology continued on page 9

World Congress of Dermatology (23rd WCD). The World Congress of Dermatology is the world’s oldest and continuous international dermatology meeting and now takes place every four years.

The first Congress in Paris in 1889 pre-dated the modern Olympics by seven years, and was last held in North America in 1992.

Four years ago in Seoul, the International League of Dermatocontinued on page 4

Today

at the World Congress

by DR. CHARLES LYNDE EDITOR of skindaily

Welcome to Vancouver, to the 23rd World Congress of Dermatology, and to the first edition of SkinDAILY, the Official Newspaper of this conference.

Very much like the city in which we have convened, the SkinDAILY intends to be expansive in its vision, pleased to engage all voices and all interests, unapologetic in its curiosity, and ready, willing and eager to try new things.

One such new thing is as close by as your mobile device. That is SkinDAILY’s mobile-friendly digital news and networking hub, located at www.derm.city.

(That is not a typo, and you have no need to add a “dotcom� when

continued on page 4

G IN EE M R O C TH IN S O E T TI 6 C I 201

Save the dates

Outstanding Canadian and International Faculty We invite you to join this landmark one-day educational congress of Dermatologists, General Practitioners, and Family Physicians committed to providing better dermatologic care for the region’s diverse and growing ethnic communities, notably Fitzpatrick Scale skin types III through VI Vital scientific curriculum: Faculty includes outstanding international and Canadian clinical thought-leaders Better care for our communities: Sessions conducted in MontrÊal, Toronto, and Vancouver, acclaimed as three of the most diverse cities in the world

Welcome to

derm.city “Where Dermatology lives� www.

derm. city

Therapeutic Challenges in Pigmented Skin, for the following conditions: Acne, Hair, Rosacea, Keloids, Lasers, Hyperpigmentation, Contact dermatitis, Hidradenitis suppurativa (HS), Steroid resistance, Sun protection, Rejuvenation, Shaving, Psoriasis

Vancouver date to be announced Toronto 8:00 am to 4:00 pm, Saturday, April 16, 2016 MontrĂŠal 8:00 am to 4:00 pm, Saturday, May 14, 2016

$99

Early-bird registration Includes all tuition and registration fees, lunch and nutrition breaks

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